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Seating

Dr. Aneela Umar


Sitting
• Sitting has been defined as a position in which
the weight of the body is transferred to a
supporting area, mainly by the ischial
tuberosities of the pelvis and their
surrounding soft tissues.
• In sitting, most of the body weight is on the
buttocks, back, and feet
• Occupational and physical therapist realize that
the issues related to sitting comfortably are not
restricted to the workplaces
• Consider students from preschool through
college who are using computers more and more.
• What type of chairs do they have? On what type
of work surfaces are the computers placed? Are
changes made to one or the other or both as a
child grow
THE BODY’S NEED FOR MOVEMENT
• We often sit because of the fatigue that results
from standing, as sitting require about 20% less
energy in comparison with standing
• Sitting is also a more efficient way to perform
many occupational and non occupational tasks as
the chair offers the necessary support and
stability
• Sitting in many jobs makes good sense, as relieves
the body’s supporting muscles (e.g., those of the
trunk and legs),
• offers them a chance to rest, and is less
demanding on the blood circulation to the legs.
Effect of sitting on muscles

• Most sitting or sedentary work tasks require the use of


the hands and arms
• with little active or dynamic movement of larger muscle
groups, these muscles are in a prolonged state of
contraction and a state of heightened tension
• Because the muscles are not afforded the benefits of
active pumping of blood that transports sugar and
oxygen to dynamically contracting muscles . This
results in the buildup of waste products such as CO2
and lactic acid, which then causes muscle spasms and
fatigue
• Movement helps increase blood flow throughout the
body to the muscles and relieves pressure on the discs
• A lack of active movement while sitting and working in
relatively flexed postures also results in static muscle
loading, which can lead to venous pooling, causing the
legs to swell.
• At the computer, keyboarding involves both static and
dynamic work, as does light assembly work when the
work object is near the operator
• Static muscle work is required by the shoulders and
arms to hold the hands
• Dynamic finger and hand motions are required to
key or manipulate objects.
• Use of a mouse is often associated with higher
static loading factors, as the mouse is not always
adjacent to the keyboard, results in extended
forward or lateral arm reaches.
chair must provide users with optimal support,
enabling them to best interface with their work
tools
• Workers need regular dynamic movement
interspersed throughout the day to relieve the
cumulative musculoskeletal strain that results
from sustained, static body postures.
ANATOMIC AND BIOMECHANICAL
CONSIDERATIONS
• Thirty-three vertebrae comprise the spine
• In standing the spine forms three natural curves:
the cervical and lumbar curves are inward
(lordosis), and the middle or thoracic curve is
outward (kyphosis)
• The cervical and lumbar portions of the spine are
mobile in relation to the thoracic spine.
• The intervertebral discs are located among the
vertebrae, act as shock absorbers, and provide
flexibility to the spine
• Ligaments provide stability to the vertebrae
and are located on the anterior and posterior
walls of the spine
• Muscles along the spine maintain posture and
provide stability to the trunk
• The nerves that comprise the spinal cord are
protected by the vertebrae and pass to the
extremities, allowing motor and sensory
information to pass to and from the brain.
Lower Body
• When sitting, the pressure falls onto the two small
“sit bones” or the ischial tuberosities. Compressive
stresses exerted on areas of the buttocks beneath
the tuberosities are high with the forces almost
doubled when sitting cross-legged.
• When one sits upright, approximately two thirds of
the body’s weight is distributed to the chair seat,
with the backrest, armrest, and floor .
• The sacrum is essentially fixed and moves in
relation to the pelvis.
• forward or anterior rotation of the pelvis causes the lumbar
spine to move toward increased lordosis to maintain an
upright trunk.
• When pelvis tilts backward, the lumbar spine tends to
flatten, causing kyphosis
• Radiographic studies shows that pelvis rotates backward and
the lumbar spine flattens during sitting
• Disc pressures also change dramatically when a person
moves among standing, upright.
• Disc pressure is greater during sitting than during standing
and that disc pressures drop with an inclination of the chair
backrest when it is tilted from vertical to 110 degrees
• Disc pressure in standing subjects were approximately 35%
lower than those measured in seated subjects.
why preserving the lumbar lordosis is
critical to healthy sitting.
• With a change to kyphosis, the body’s center
of gravity shifts from over the lumbar spine to
in front of it.
• With the shift of upper body weight, the space
between lumbar discs is compromised,
causing low back muscle fatigue and pressure
on the lumbar discs, disrupting the normal
equilibrium.
SITTING POSTURES
1. RECLINED POSTURES,
• the seat and backrest are tilted backward and the
center of body mass is behind the ischial
tuberosities.
• This posture reduces the pressure on the discs, it is
not functional for working because increases the
viewing distance and arm reach to the work area.
• It can also increase strain on the neck if the user fl
exes his or her head forward for viewing, without
the benefits of a high backrest or even a headrest
2. UPRIGHT POSTURE,
involve the trunk being upright and straight, with the
seat and backrest at an approximate 90-degree angle
and the center of body mass over the ischial
tuberosities
3. FORWARD POSTURE,
the seat and backrest are tilted forward, placing the
center of mass in front of the ischial tuberosities.
• These postures are usually assumed in relation to the
task for e.g fine detail work often involves leaning
forward, telephon conversations can be conducted
while reclined, and work at a keyboard is usually
performed in an upright postur
EMG studies
• Emg study of back muscles shows that
• myoelectric activity decreases when the back support is
located in the lumbar region rather than in the thoracic
region
• supporting the sacrum and lower thoracic spine is necessary
to achieve proper sitting posture.
• Without sacral support to produce an anterior pelvic tilt, the
sacrum rotates posteriorly, bringing the lumbar spine into a
flattened or kyphotic position.
• Forward seat-pan tilt, can reduce pressure on the discs
and increase the lordosis.
• Issue for many workers is a feeling that they are sliding
from the seat. This issue can adjusted by seat height
adjustments, which require increasing the overall seat
height and providing proper support beneath the feet
• EMG shows that sitting in a reclined position relaxes
the trunk muscles and requires minimal muscle activity
to hold the body weight in balance. However pressures
are greatest when a person sits with reclined position .
• Similarly, although the reclined sitting is associated
with lesser disc pressure, this cannot be a functional
work position, associated extended reaches to the
work area will again throw off the body’s equilibrium
• Prolonged sitting can also cause compression of the
sciatic nerve, resulting in paresthesias.
• Proper positioning and support are also important
when sitting because of circulatory issues related to
the lower extremities being in a dependent position
and vulnerability of the popliteal area behind the knee
• This can result in restricted circulation if the two major
veins are compressed by the weight of the body or
from a seat pan that is too deep and does not provide 1
to 2 inches of clearance between the seat edge and
back of the knees.
• Supporting the legs with either the floor itself or a
footrest can help minimize this effect, and that
movement every 15 minutes can reduce swelling up to
2.3%
Upper Body
• When one is sitting, the lower spine provides basic support and the
upper or cervical spine supports the head for viewing, whether
looking forward to a computer screen or down to written text or the
work item
• Neutral postures of the head (e.g., without extreme flexion, rotation,
or side bending) and maintaining the arms near the torso are
associated with less musculoskeletal stress
• in head position, reflected by changes in the movement distance
between the axis of motion and the head’s center of gravity, can
show fivefold increase acting on the erector spinae muscle
• Almost two-and-one-half–fold increase in the reaction force on the
C5 disc when comparing erect postures with 45-degree flexed
postures for screen viewing.
• when the head is held forward for extended periods of
time, increased posterior cervical muscle activity is
required to support the weight of the head, resulting in
increased muscle fatigue
• The line of vision dictates head and neck posture If the
work surface is too low or the computer screen is too far
away from the user, neck and trunk flexion result.
• If work items are located to the sides, there is increased
strain on the lateral support muscles, as the head rotates to
allow viewing of the work item (e.g., a monitor that is not
positioned in-line relative to the keyboard)
• small muscles of the forearms and hands are
undergoing near constant dynamic contractions,
the proximal muscles of the shoulders and neck
statically contract to provide postural support
• EMG activity of the trapezius muscle reached 20%
to 30% during keyboard operations
• Having the arms supported has been found to
decrease activity levels of the trapezius muscle
activity.
Problems Associated with Office and
Industrial Chairs
• The backrest is not easily adjustable and offers limited range
of adjustment to provide adequate low back support.
• Older industrial chairs lack padding, have sharp edges that
may pose pinch points, and have a four-legged base of
support
• The seat height adjustment on manually adjusted chairs is
controlled by spinning the seat clockwise to raise and
counterclockwise to lower the seat. This adjustment cannot
be made by the seated worker, and this mechanism tends to
break over time.
• The tension control knob difficult to reach because it is
under or behind the seat.most workers are unfamiliar with
the purpose of this knob and rarely use it.
• The seat may be too deep for shorter people, causing
their feet to dangle and their legs to swell. To avoid
pressure behind the legs, these users lean forward to
access the work area and do not receive the benefits of
back support.
• Chair armrests are often too wide, too low, or too high
to be used. Armrests that are too high can interfere
with the user’s ability to pull the chair under the work
surface, forcing the worker to sit forward on the seat,
foregoing the benefit of the backerst.
ERGONOMIC CHAIR DESIGN
AND SELECTION
• Good ergonomic chair design provides easily adjustable
and accessible features for seat height, backrest and
level of lumbar support, and seat inclination
• Three basic chair designs
• FIXED POSTURE CHAIRS tend to lock the person into the
one so-called “ideal” or “preferred” posture by means
of static posture settings.
• DYNAMIC CHAIR DESIGNS move with the person, are
free-flowing or move continuously with the user, and
have easily adjusted changes in backrest inclination
• COMBINATION CHAIRS allow the user to both lock the
chair into select positions of support and keep it
“freefloating for others.”
example,

users in combination chairs can keep the backrest


essentially locked in an upright posture (offering back
support) when typing allow for freedom of back
movement while on a conference call that does not
involves simultaneous viewing of the screen, data
input.
BASIC FEATURES OF A WELL-DESIGNED
ERGONOMIC CHAIR
• A seat height that is easily adjustable and has
pedestal base
• Ability of the user to easily make all adjustments
while seated
• Good lumbar support
• A backrest that adjusts vertically to support lumbar
spine as well as in anteriorposterior direction and
that is narrow enough to allow freedom of arm
movement without chair interference
• Dynamic movement options of the backrest and seat
pan, preferably with independent movement of the two
• A seat pan with a curved front or waterfall edge to
reduce pressure behind the knees
• A tension adjustment that affects the ease of forward
and backward inclination of the backrest
• A five-prong base of support to prevent the chair from
tipping
• Casters that are sturdy and allow for both mobility and
stability
• Seat padding that is soft but not too soft, to
allow even distribution of pressure
Special Situations and
Nonconventional Chairs
• Balans chair.
This chair features a half-sitting, half-kneeling posture, with a
forward-tilted seat and knee support. This design results in a
wider hip angle and maintains the three natural curves of the
spine, preserving lumbar lordosis.
• Studies reported the load on the knees and lower legs is too
great in this seated posture and becomes painful.
• Use of this design is also contraindicated when users need to
get up and down frequently to perform diverse work tasks
• This design can be helpful when sitting at a dedicated
workstation (or even,at the television) that does not require
frequent upper body movement and in persons without knee
problems.
• visually intensive work requires the user to lean
forward to clearly view or access the work area (e.g.,
for persons working at a microscope or performing
industrial and electronic assembly and inspection,
drafting and engineering, dentistry, or surgery).
• Sitting in a supported forward-inclined position can
help relieve back and neck fatigue, especially for
persons with issues related to the cervical spine
• Two chairs in particular address this issue:
• the HÅG Capisco stool and the Neutral Posture
AbStool or AbChair .
• In both of these chairs, the backrest, which in the
former chair has a saddle-like design and in the latter is
like a big cushioned roll, can be rotated 180 degrees so
that the chair offers a front rest or abdominal support
when the user leans over.
Neutral Posture’s AbStool (or AbChair)
can offer users support when the pillow backrest is
in front or behind the torso
HÅG Capisco chair
• it offers the opportunity to lean forward with support
or sit with the backrest in a more traditional posture
and sit upright at both work benches.
• Provides back and torso support.
Stance Chair
• multiposture sitto-stand shifting chair, and
various models of the Ergoquest adjustable-
height workstation, which can be used in
supine, seated, or standing work positions.
• The use of wall-mounted large liquid crystal
display (LCD) monitors and/or flat panel
television screens is another option that allows
people with severe back disabilities to work
from bed or reclined chair postures.
The Stance Angle Chair can be adapted to sitting, kneeling, and
standing postures. This photograph illustrates a standing work
posture, in conjunction with the TaskMate Height Adjustable
Monitor and Keyboard Positioning Unit
SEATING STANDARDS
• Workstations canvass draft refers to four reference postures
for computer operators
• RECLINED SITTING, in which the user’s torso
and neck recline between 105 and 120 degrees
• UPRIGHT SITTING, in which the user’s torso and neck are
approximately vertical and in line (between 90 and 105
degrees , the thighs are approximately horizontal, and the
lower legs are vertical
• DECLINED SITTING, in which the user’s thighs are inclined
below the horizontal, the torso is vertical or slightly reclined
behind the vertical, and the angle between the thighs and
torso is greater than 90 degrees
• STANDING, in which the user’s legs, torso, neck, and head
are approximately in line and vertical
ANSI recommends the
following:
• A backrest that reclines, that does not constrain the user’s
torso to a position forward of vertical or force a torso-thigh
angle less than 90 degrees, and that allows for adjustments
of the angle between the backrest and seat to an angle of 90
degrees or greater
• A seat pan that adjusts for height and tilt,
that is wide enough and that is of sufficient depth to allow the
user’s back to be supported by the backrest yet allows
clearance between the knee and seat edge
• The chair should provide support to the user’s back and
thighs in the chosen reference positions
• The chair should support at least one other seated
reference posture in addition to the upright seated posture
EMPLOYEE EDUCATION
• Therapists may gain entry to the workplace by several
routes, for example,
• as an extension of a return-to-work program or need to
develop appropriate job accommodations or as
industrial therapists who provide full ergonomic
workplace assessments and wellness or ergonomic
training.
• The therapist can influence industry practices not only
by providing employee education, but by educating
managers, supervisors, occupational medicine, safety
and human resources personnel, and purchasing agents
about the health and comfort needs of seated workers,
proper chair selection, and general ergonomics
• Managers and purchasing agents often feel that once a new
ergonomic chair has arrived on the workfloor, they have
done all that is required with regard to that chair. However,
receiving the chair is only the first step
• Employee education and training are paramount to ensure
that all users understand how their chairs work and how to
use them in relation to the total workstation.
• An ergonomic chair, as with all ergonomic equipment, cannot
be fully effective unless it fits workers properly and users are
properly trained in its adjustment features.
• Too often, employees who have used a chair for several
months never realize several of its basic adjustment features
• Demonstrate the various adjustment features on chairs to
employees
• Employees need to be present for their ergonomic
workstation evaluation, as an ergonomist or therapist cannot
make informed recommendations without seeing the user
interfacing with his or her equipment or work area.
• Ergonomics awareness seminars integrate the
therapist’s knowledge of anatomy, physiology,
kinesiology, biomechanics, and task or job analysis.
• To emphasize the health benefits of good posture,
therapists should actively engage their audience.
• Demonstrations with spine models help illustrate
issues related to proper alignment and relative
changes in disc pressure
• Trainees should be encouraged to assume preferred
sitting postures: with approximate 90- degree angles
at the hips, knees, and ankles; feet firmly on floor;
shoulders aligned over the hips; and the head over the
shoulders to help preserve the natural spinal curves.

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